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CORK Bibliography: Cognitve Behavioral Therapy

45 citations. January 2010 to present

Prepared: March 2011

Baha MY; Le Faou AL. Smoking cessation interventions offered to French adult light smokers: A heterogeneous population with specific needs. European Addiction Research 16(3): 162-169, 2010. (22 refs.)

Aims: We addressed the understudied topic of cessation interventions for adult light smokers (<= 10 cigarettes daily). We identified cessation aids offered in French cessation services and their impact on cessation outcomes at 1-month follow-up. Methods: We retrospectively analyzed data from 36,594 smokers in cessation services nationwide. Smokers could be offered pharmacotherapy as well as cognitive behavioral therapy (CBT). Bivariate methods and multivariate logistic regression analyses were used. Results: Light smokers were 1.23 times more likely to drop out than heavy smokers. 13.3% were abstinent at follow-up versus 14.5% for heavy smokers (p = 0.013). Light smokers were offered pharmacotherapy less often than heavy smokers. Yet, among light smokers, varenicline doubled the odds of abstinence as did nicotine patch. CBT improved abstinence only when combined with nicotine patch. Intervention outcomes differed according to various profiles: light smokers self-referred or with several previous quit attempts achieved better outcomes than those not interested in quitting or referred through hospitalization. Conclusion: Light smokers' poor intervention out-comes might partly be explained by inadequate treatment plans in French cessation services. Our results reveal that pharmacotherapy is effective and that tailored CBT should be offered according to the variety of profiles among light smokers.

Brewer JA; Sinha R; Chen JA; Michalsen RN; Babuscio TA; Nich C et al. Mindfulness training and stress reactivity in substance abuse: Results from a randomized, controlled stage I pilot study. Substance Abuse 30(4): 306-317, 2009. (57 refs.)

Stress is important in substance use disorders (SUDs). Mindfulness training (MT) has shown promise for stress-related maladies. No studies have compared MT to empirically validated treatments for SUDs. The goals of this study were to assess MT compared to cognitive behavioral therapy (CBT) in substance use and treatment acceptability, and specificity of MT compared to CBT in targeting stress reactivity. Thirty-six individuals with alcohol and/or cocaine use disorders were randomly assigned to receive group MT or CBT in an outpatient setting. Drug use was assessed weekly. After treatment, responses to personalized stress provocation were measured. Fourteen individuals completed treatment. There were no differences in treatment satisfaction or drug use between groups. The laboratory paradigm suggested reduced psychological and physiological indices of stress during provocation in MT compared to CBT. This pilot study provides evidence of the feasibility of MT in treating SUDs and suggests that MT may be efficacious in targeting stress.

Brooks AC; Comer SD; Sullivan MA; Bisaga A; Carpenter KM; Raby WM. Long-acting injectable versus oral naltrexone maintenance therapy with psychosocial intervention for heroin dependence: A quasi-experiment. Journal of Clinical Psychiatry 71(10): 1371-1378, 2010. (23 refs.)

Objective: To conduct a quasi-experimental comparison of early clinical outcomes between injectable, sustained-release, depot naltrexone formulation versus oral naltrexone maintenance therapy in individuals with opiate dependence. Method: Early retention in treatment and urine-confirmed opiate use in the first 8 weeks postdetoxification were compared between patients (diagnosed as opiate-dependent according to DSM-IV criteria) participating in 2 concurrently run randomized clinical trials of oral (n = 69; patients treated from September 1999 to May 2002) and long-acting injectable (n = 42; patients treated from November 2000 to June 2003) naltrexone maintenance therapy with psychosocial therapy. Results: Long-acting injectable naltrexone produced significantly better outcome than oral naltrexone on days retained in treatment (F-1,F-106 = 6.49, P = .012) and for 1 measure of opiate use (F-1,F-106 = 5.26, P = .024); other measures were not significantly different, but differences were in the same direction. In subanalyses, there were interaction effects between baseline heroin use severity and type of treatment. In subanalyses, heroin users with more severe baseline use showed better retention with oral naltrexone maintenance therapy combined with intensive psychotherapy (behavioral naltrexone therapy) as compared to retention shown by severe heroin users treated with long-acting naltrexone injections combined with standard cognitive-behavioral therapy (chi(2)(1) = 9.31, P = .002); less severe heroin users evidenced better outcomes when treated with long-acting injectable naltrexone. Conclusions: This quasi-experimental analysis provides tentative indications of superior outcomes for heroin-dependent patients treated with long-acting injectable naltrexone compared to oral naltrexone. The finding that heroin users with more severe baseline use achieved better outcomes with oral naltrexone is most probably attributable to the intensive nature of the psychosocial treatments provided and points to the opportunity for continued research in augmenting injectable naltrexone with psychosocial strategies to further improve outcome, especially in individuals with more severe use. The results should be considered exploratory given the quasi-experimental nature of the study.

Buckner JD; Carroll KM. Effect of anxiety on treatment presentation and outcome: Results from the Marijuana Treatment Project. Psychiatry Research 178(3): 493-500, 2010. (52 refs.)

Despite emerging evidence of the efficacy of psychotherapies for marijuana dependence, variability in outcome exists. This study examined the role of anxiety on treatment involvement and outcome. Four questions were examined: (1) Is greater anxiety associated with greater impairment at baseline? (2) Is baseline anxiety related to greater marijuana use and problems following treatment? (3) Does adding cognitive-behavioral therapy (CBT) to motivation enhancement therapy (MET) reduce anxiety relative to MET alone; (4) Are reductions in anxiety associated with better outcomes? The sample comprised 450 marijuana-dependent patients in the Marijuana Treatment Project. Marijuana use and anxiety were measured at pretreatment and 4- and 9-month follow-ups. At baseline, anxiety was linked to more marijuana-related problems. CBT was associated with less anxiety at follow-up compared to MET alone. Reductions in anxiety were related to less marijuana use. In fact, reduction in anxiety from baseline to 4-month follow-up was associated with less marijuana use at 9 months, but reduction in marijuana use did not predict subsequent anxiety. Data suggest that anxiety is an important variable that deserves further attention in marijuana-dependence treatment.

Burke BL. What can motivational interviewing do for you? (editorial). Cognitive and Behavioral Practice 18(1): 74-81, 2011. (51 refs.)

Motivational Interviewing (MI) is a promising 25-year-old therapeutic approach that integrates relationship-building principles and more directive strategies to move clients toward behavioral change. A large and expanding number of controlled research studies of MI have demonstrated its efficacy for addictive behaviors ranging from use of alcohol, nicotine, cocaine, heroin, and marijuana to gambling. This commentary highlights how the articles in this special series have answered two interrelated remaining questions about MI: first, whether it works beyond addictions; second, whether it adds significantly to the efficacy of cognitive behavioral therapy (CBT) when combined with it as either a pretreatment or throughout treatment. The articles in this series provide excellent rationales for why MI should work for problems such as eating disorders, depression, anxiety, and suicide, and why combining it with CBT should enhance client outcomes for each of these areas. However, there is a paucity of research data-especially from clinical trials-to support the theories, leaving practitioners with a conflict between the two intertwined poles of practice and science.

Chapman S; MacKenzie R. The global research neglect of unassisted smoking cessation: Causes and consequences. PLoS Medicine 7(2): e1000216, 2010. (71 refs.)

This article discussses the lack of attention to unaided smoking cesssation. The major points are as follows: 1.) research shows that two-thirds to three-quarters of ex-smokers stop unaided. In contrast, the increasing medicalisation of smoking cessation implies that cessation need be pharmacologically or professionally mediated. 2.) Most published papers of smoking cessation interventions are studies or reviews of assisted cessation; very few describe the cessation impact of policies or campaigns in which cessation is not assisted at the individual level. 3.) Many assisted cessation studies, but few if any unassisted cessation studies, are funded by pharmaceutical companies manufacturing cessation products. and 4.) Health authorities should emphasise the positive message that the most successful method used by most ex-smokers is unassisted cessation.

Cornelius JR; Bukstein OG; Douaihy AB; Clark DB; Chung TA; Daley DC et al. Double-blind fluoxetine trial in comorbid MDD-CUD youth and young adults. Drug and Alcohol Dependence 112(1-2): 39-45, 2010. (51 refs.)

Objective: This study compared the acute phase (12-week) efficacy of fluoxetine versus placebo for the treatment of the depressive symptoms and the cannabis use of adolescents and young adults with comorbid major depression (MDD) and a cannabis use disorder (CUD) (cannabis dependence or cannabis abuse). We hypothesized that fluoxetine would demonstrate efficacy versus placebo for the treatment of the depressive symptoms and the cannabis use of adolescents and young adults with comorbid MDD/CUD. Methods: We conducted the first double-blind placebo-controlled study of fluoxetine in adolescents and young adults with comorbid MDD/CUD. All participants in both treatment groups also received manual-based cognitive behavioral therapy (CBT) and motivation enhancement therapy (MET) during the 12-week course of the study. Results: Fluoxetine was well tolerated in this treatment population. No significant group-by-time interactions were noted for any depression-related or cannabis-use related outcome variable over the 12-week study. Subjects in both the fluoxetine group and the placebo group showed significant within-group improvement in depressive symptoms and in number of DSM diagnostic criteria for a CUD. Large magnitude decreases in depressive symptoms were noted in both treatment groups, and end-of-study levels of depressive symptoms were low in both treatment groups. Conclusions: Fluoxetine did not demonstrate greater efficacy than placebo for treating either the depressive symptoms or the cannabis-related symptoms of our study sample of comorbid adolescents and young adults. The lack of a significant between-group difference in these symptoms may reflect limited medication efficacy, or may result from efficacy of the CBT/MET psychotherapy or from limited sample size.

Cropsey KL; Jackson DO; Hale GJ; Carpenter MJ; Stitzer ML. Impact of self-initiated pre-quit smoking reduction on cessation rates: Results of a clinical trial of smoking cessation among female prisoners. Addictive Behaviors 36(1-2): 73-78, 2011. (26 refs.)

Objectives: This study examined differences in cessation success based on smokers self-initiated pre-quit reductions in cigarettes per day (cpd) Methods: The study utilized data from a nicotine replacement + behavioral therapy smoking cessation intervention conducted in a female prison facility with 179 participants who were wait-listed for 6 months prior to intervention We compared two groups of smokers based on whether they self-selected to reduce smoking prior to their cessation attempt (n = 77) or whether they increased smoking or did not reduce (n = 102) General Estimating Equations (GEE) were used to model smoking cessation through 12 month follow-up. Results: Examination of pre-cessation cpd showed that those who reduced were heavier smokers at baseline relative to those who did not reduce (p<0 001) By the week prior to the quit attempt (week 3) heavier smokers at baseline smoked significantly fewer cigarettes (p<0 001) and had lower CO levels (p<0 05) compared to baseline lighter smokers GEE analyses showed that individuals who reduced prior to their quit attempt had significantly higher quit rates during early treatment but these gains were not sustained by follow-up points. Conclusions: Participant initiated pre-cessation smoking reduction may be initially helpful in preparing to quit smoking or may serve as a marker for participant motivation to quit smoking but these differences do not sustain over time. More intensive interventions are still needed for successful cessation.

Das S; Harel O; Dey DK; Covault J; Kranzler HR. Analysis of extreme drinking in patients with alcohol dependence using Pareto regression. Statistics in Medicine 29(11): 1250-1258, 2010. (25 refs.)

We developed a novel Pareto regression model with an unknown shape parameter to analyze extreme drinking in patients with Alcohol Dependence (AD). We used the generalized linear model (GLM) framework and the log-link to include the covariate information through the scale parameter of the generalized Pareto distribution. We proposed a Bayesian method based on Ridge prior and Zellner's g-prior for the regression coefficients. Simulation study indicated that the proposed Bayesian method performs better than the existing likelihood-based inference for the Pareto regression. We examined two issues of importance in the study of AD. First, we tested whether a single nucleotide polymorphism within GABRA2 gene, which encodes a subunit of the GABA(A) receptor, and that has been associated with AD, influences 'extreme' alcohol intake and second, the efficacy of three psychotherapies for alcoholism in treating extreme drinking behavior. We found an association between extreme drinking behavior and GABRA2. We also found that, at baseline, men with a high-risk GABRA2 allele had a significantly higher probability of extreme drinking than men with no high-risk allele. However, men with a high-risk allele responded to the therapy better than those with two copies of the low-risk allele. Women with high-risk alleles also responded to the therapy better than those with two copies of the low-risk allele, while women who received the cognitive behavioral therapy had better outcomes than those receiving either of the other two therapies. Among men, motivational enhancement therapy was the best for the treatment of the extreme drinking behavior.

Ebbert JO; Edmonds A; Luo XH; Jensen J; Hatsukami DK. Smokeless tobacco reduction with the nicotine lozenge and behavioral intervention. Nicotine & Tobacco Research 12(8): 823-827, 2010. (13 refs.)

Introduction: Studies have evaluated smoking reduction with nicotine replacement therapy to reduce tobacco exposure and facilitate abstinence among cigarette smokers, but none have evaluated a reduction approach in smokeless tobacco (ST) users. Methods: We conducted an open-label pilot study to determine if the 4-mg nicotine lozenge with a behavioral intervention could facilitate ST use reduction among ST users compared with a behavioral intervention alone. Eligible subjects were ST users not interested in quitting. Results: One hundred and two subjects were randomized. Both interventions were associated with significant decreases in ST use and toxicant exposure and with increased abstinence, quit attempts, and duration of abstinence. However, no significant differences were observed between groups for these outcomes. Discussion: A behavioral intervention with or without the nicotine lozenge may be effective for decreasing both ST use and toxicant exposure and for increasing tobacco abstinence, quit attempts, and duration of abstinence. The use of reduction strategies for ST users not interested in quitting deserves further evaluation as an intervention strategy.

Gibbons CJ; Nich C; Steinberg K; Roffman RA; Corvino J; Babor TF et al. Treatment process, alliance and outcome in brief versus extended treatments for marijuana dependence. Addiction 105(10): 1799-1808, 2010. (49 refs.)

Aims: The Marijuana Treatment Project, a large multi-site randomized clinical trial, compared a delayed treatment control condition with a brief (two-session) and extended (nine-session) multi-component treatment among 450 marijuana-dependent participants. In this report we present treatment process data, including the fidelity of treatment delivery in the three community-based treatment settings as well as the relationships between treatment process and outcome. Design: Independent evaluations of clinician adherence and competence ratings were made based on 633 videotaped sessions from 163 participants. Relationships between clinician adherence and competence, ratings of the working alliance and marijuana treatment outcomes were evaluated. Findings: Protocol treatments were implemented with strong fidelity to manual specifications and with few significant differences in adherence and competence ratings across sites. In the brief two-session treatment condition, only the working alliance was associated significantly with frequency of marijuana use, but in the extended treatment therapist ratings of working alliance predicted outcomes, as did the interaction of alliance and curvilinear adherence. Conclusions: Behavioral treatments for marijuana use were delivered in community settings with good fidelity. Participant and therapist working alliance scores were associated significantly with improved marijuana use outcomes in a brief behavioral treatment for adults with marijuana dependence. In extended treatment the therapist ratings of working alliance were associated with more positive outcome. However, in that treatment there was also a significant interaction between alliance and curvilinear adherence.

Godley SH; Garner BR; Passetti LL; Funk RR; Dennis ML; Godley MD. Adolescent outpatient treatment and continuing care: Main findings from a randomized clinical trial. Drug and Alcohol Dependence 110(1-2): 44-54, 2010. (63 refs.)

This study evaluated the effectiveness and cost-effectiveness of two types of outpatient treatment with and without Assertive Continuing Care (ACC) for 320 adolescents with substance use disorders. Study participants were randomly assigned to one of four conditions: (a) Chestnut's Bloomington Outpatient Treatment (CBOP) without ACC; (b) CBOP with ACC; (c) Motivational Enhancement Therapy/Cognitive Behavior Therapy-7 session model (MET/CBT7) without ACC; and (d) MET/CBT7 with ACC. All study conditions attained high rates of participant engagement and retention. Follow-up interviews were completed with over 90% of the adolescents at three, six, nine, and 12 months after treatment admission. There was a significant time by condition effect over 12 months, with CBOP having a slight advantage for average percentage of days abstinent. Unlike previous findings that ACC provided incremental effectiveness following residential treatment, there were no statistically significant findings with regard to the incremental effectiveness of ACC following outpatient treatment. Analysis of the costs of each intervention combined with its outcomes revealed that the most cost-effective condition was MET/CBT7 without ACC.

Heinzerling KG; Swanson AN; Kim S; Cederblom L; Moe A; Ling W et al. Randomized, double-blind, placebo-controlled trial of modafinil for the treatment of methamphetamine dependence. Drug and Alcohol Dependence 109(1-3): 20-29, 2010. (56 refs.)

Objective: To compare modafinil to placebo for reducing methamphetamine (MA) use, improving retention, and reducing depressive symptoms and MA cravings. Rates of adverse events and cigarette smoking with modafinil versus placebo were also compared. Methods: Following a 2-week, non-medication lead-in period, 71 treatment-seeking MA-dependent participants were randomly assigned to modafinil (400 mg once daily; N = 34) or placebo (once daily; N = 37) for 12 weeks under double-blind conditions. Participants attended clinic thrice-weekly to provide urine samples analyzed for MA-metabolite, to complete research assessments, and to receive contingency management and weekly cognitive behavioral therapy (CBT) sessions. Results: There were no statistically significant effects for modafinil on MA use, retention, depressive symptoms, or MA cravings in pre-planned analyses. Outcomes for retention and MA use favored modafinil in a post hoc analysis among participants with low CBT attendance and among participants with baseline high-frequency of MA use (MA use on >18 of past 30 days), but did not reach statistical significance in these small subgroups. Modafinil was safe and well tolerated and did not increase cigarette smoking. Conclusions: Modafinil was no more effective than placebo at 400 mg daily in a general sample of MA users. A post hoc analysis showing a trend favoring modafinil among subgroups with baseline high-frequency MA use and low CBT attendance suggests that further evaluation of modafinil in MA users is warranted.

Hendricks PS; Delucchi KL; Hall SM. Mechanisms of change in extended cognitive behavioral treatment for tobacco dependence. Drug and Alcohol Dependence 109(1-3): 114-119, 2010. (48 refs.)

Aim: To evaluate potential mediators of an extended cognitive behavioral smoking cessation intervention. Design: Analysis of data from a randomized clinical trial of smoking cessation. Setting: The Habit Abatement Clinic, University of California, San Francisco. Participants: Participants were older cigarette smokers (>= 50 years old). Those receiving Standard Treatment (N = 100) were compared to those receiving extended cognitive behavioral treatment (N = 99). Measurements: Negative affect was measured with the Profile of Mood States (POMS), the Medical Outcome Studies 36-item Short-Form Health Survey (SF-36), and the Perceived Stress Scale (PSS). Abstinence-specific social support was measured with the Partner Interaction Questionnaire (PIQ). Motivation to quit and abstinence self-efficacy were measured on 1-10 scales with the Thoughts about Abstinence Questionnaire. All were measured at the beginning of treatment and week 52. Results: Analyses revealed that extended CBT increased abstinence self-efficacy over the first 52 weeks postcessation. This effect, in turn, was positively associated with 7-day point prevalence abstinence at week 64 while controlling for treatment condition, and eliminated the independent effect of treatment condition on abstinence. The test of mediation indicated a significant effect, and abstinence self-efficacy accounted for 61% to 83% of the total effect of treatment condition on smoking abstinence. Results failed to support a mediational role of negative affect, abstinence-specific social support, or motivation to quit. Conclusions: The results of the present study are consistent with theories of relapse and studies of more time-limited interventions, and underscore the importance of abstinence self-efficacy in achieving long-term abstinence from cigarettes.

Hides L; Samet S; Lubman DI. Cognitive behaviour therapy (CBT) for the treatment of co-occurring depression and substance use: Current evidence and directions for future research. Drug and Alcohol Review 29(5): 508-517, 2010. (81 refs.)

Issues and Approach. The high rates of co-occurring depression and substance use, and the negative impact of this on illness course and outcomes have been well established. Despite this, few clinical trials have examined the efficacy of cognitive behaviour therapy (CBT). This paper systematically reviews these clinical trials, with an aim of providing recommendations for how future research can develop a more robust evidence base for the treatment of these common comorbidities. Leading electronic databases, including PubMed (ISI) and PsychINFO (CSA), were searched for peer-reviewed journal articles using CBT for the treatment of co-occurring depression and substance use. Of the 55 articles identified, 12 met inclusion criteria and were included in the review. Key Findings. There is only a limited evidence for the effectiveness of CBT either alone or in combination with antidepressant medication for the treatment of co-occurring depression and substance use. While there is support for the efficacy of CBT over no treatment control conditions, there is little evidence that CBT is more efficacious than other psychotherapies. There is, however, consistent evidence of improvements in both depression and substance use outcomes, regardless of the type of treatment provided and there is growing evidence that that the effects of CBT are durable and increase over time during follow up. Conclusions. Rather than declaring the 'dodo bird verdict' that CBT and all other psychotherapies are equally efficacious, it would be more beneficial to develop more potent forms of CBT by identifying variables that mediate treatment outcomes.

Hodge DR. Alcohol treatment and cognitive behavioral therapy: Enhancing effectiveness by incorporating spirituality and religion. Social Work 56(1): 21-31, 2011. (104 refs.)

Cognitive behavioral therapy (CBT) is an effective modality for the treatment of alcoholism. Given widespread interest in incorporating spirituality into professional treatment, this article orients practitioners to spiritually modified CBT, an approach that may enhance outcomes with some spiritually motivated clients. More specifically, by integrating clients' spiritual beliefs and practices into treatment, this modality may speed recovery, enhance treatment compliance, prevent relapse, and reduce treatment disparities by providing more culturally congruent services. The process of constructing spiritually modified CBT self-statements is described and illustrated, and suggestions are provided for working with client spirituality in an ethical manner. The article concludes by emphasizing the importance of this approach in light of the growing spiritual diversity that characterizes contemporary society.

Houben K. Learning to quit drinking: An impulsive and reflective route to behavioral change. Psychologie & Gezondheid 36(4): 153-162, 2010. (28 refs.)

According to contemporary dual-process theories, alcohol misuse is the result of an imbalance between two distinct cognitive systems: An impulsive system and a reflective system. While the automatic impulsive system becomes hypersensitive to alcohol-related reward with prolonged alcohol abuse, the slower reflective system is weakened and is no longer able to inhibit automatic impulses to drink alcohol. The clinical implication of these insights is that interventions might benefit from procedures that either change the impulsive system or strengthen inhibitory control abilities. These two potential routes to behavioral change were examined in two separate studies. The first study demonstrates that the reward value assigned to alcohol can be reduced via an evaluative conditioning procedure that consistently pairs alcohol-related stimuli with negative affect. Moreover, this procedure did not only change alcohol-related affect, but also resulted in a significant decrease in alcohol intake. The second study aimed to increase response inhibition by having participants consistently stopping or inhibiting responses to alcohol-related stimuli. This inhibition training also decreased alcohol-related affective value and significantly reduced alcohol consumption. Together these two studies demonstrate that evaluative conditioning and strengthening response inhibition can be effective strategies to reduce excessive alcohol use. These two studies, therefore, provide initial data suggesting the potential utility of two novel, conceptually-derived interventions for reducing drinking.

Hunter-Reel D; McCrady BS; Hildebrandt T; Epstein EE. Indirect effect of social support for drinking on drinking outcomes: The role of motivation. Journal of Studies on Alcohol and Drugs 71(6): 930-937, 2010. (35 refs.)

Objective: This study tested an integrated relapse model drawing hypotheses from both interpersonal and intra-individual relapse models. It was hypothesized that the relationships between alcohol-specific social support (support for drinking and support for not drinking) and drinking outcomes would be partially mediated by motivation. Method: Participants were 158 women with alcohol use disorders participating in two linked randomized controlled trials. One trial compared standard individual cognitive behavioral therapy (CBT) for alcohol use disorders with female-specific CBT for alcohol use disorders; the other compared alcohol behavioral couple therapy with blended individual CBT and alcohol behavioral couple therapy. Measures included the Important People Interview to measure social-support variables, the Time-line Followback to measure drinking variables, and the Stages of Change Readiness and Treatment Eagerness Scale to measure motivation. Results: Results of structural equation modeling suggested a mediational role of motivation in the relationship between support for drinking and drinking frequency. Individuals with more network support for drinking at baseline had less motivation for abstinence at the end of treatment, which predicted drinking frequency over the 6 months after treatment. The indirect effect of baseline support for thinking on 6-month follow-up drinking frequency was statistically significant. A similar, although only marginally significant, pattern was found for the relationship between support for not drinking and drinking frequency. Individuals with more social network for not drinking at baseline had more motivation at the end of treatment at the trend level, which in turn predicted 6-month follow-up drinking frequency. The indirect effect of baseline support for not drinking on 6-month follow-up drinking frequency trended toward significance. Conclusions: This study offers preliminary evidence that motivation is one mechanism by which abstinence-specific social support affects treatment outcome.

Kapson HS; Haaga DAF. Depression vulnerability moderates the effects of cognitive behavior therapy in a randomized controlled trial for smoking cessation. Behavior Therapy 41(4): 447-460, 2010. (63 refs.)

Several clinical trials have tested the hypothesis that smoking cessation treatments with a mood management component derived from cognitive behavior therapy (CBT) for depression would be specifically effective for depression-vulnerable smokers, with mixed results. This trial addressed methodological concerns with some of the previous studies to clarify whether depression vulnerability does in fact moderate CBT smoking cessation outcome. The study compared 8-session group CBT with a time-matched comparison group condition in a sample of 100 cigarette smokers randomized to treatment condition. Each treatment group was led by one of 7 American University clinical psychology graduate students; therapists were crossed with treatment conditions. Outcome (7-day point prevalence abstinence) was evaluated 1 month and 3 months after quit date. Baseline self-reported depression vulnerability (sample median split on the Depression Proneness Inventory) moderated treatment response, such that more depression-prone smokers fared better in CBT whereas less depression-prone smokers fared better in the comparison condition. These results may have implications for determining when to use CBT components in smoking cessation programs.

Killen JD; Fortmann SP; Murphy GM; Hayward C; Fong D; Lowenthal K et al. Failure to improve cigarette smoking abstinence with transdermal selegiline plus cognitive behavior therapy. Addiction 105(9): 1660-1668, 2010. (45 refs.)

Aims: To examine the effectiveness of transdermal selegiline for producing cigarette smoking abstinence. Design: Adult smokers were randomly assigned to receive selegiline transdermal system (STS) or placebo given for 8 weeks. All participants received cognitive behavior therapy (CBT). Follow-ups were conducted at 25 and 52 weeks. Setting: Community smoking cessation clinic. Participants: 243 adult smokers (>= 18 years of age; >= 10 cigarettes/day). Measures: Expired-air carbon monoxide confirmed 7-day point prevalence abstinence. Findings STS was not superior to placebo. More women than men were abstinent at 52 week follow-up (28% vs 16%, P < 0.05). Behavioral activation (BAS) moderated treatment response (P = 0.01). The survival rate through week 52 for those with high 'drive' scores on the BAS was 47% if assigned to selegiline and 34% if assigned to placebo. The survival rate for those with low 'drive scores' on the BAS was 35% if assigned to selegiline compared to 53% if assigned to placebo. Conclusion: Transdermal selegiline does not appear generally effective in aiding smoking cessation though there may be a selective effect in those smokers with low 'behavioral activation'.

Kiluk BD; Nich C; Babuscio T; Carroll KM. Quality versus quantity: Acquisition of coping skills following computerized cognitive-behavioral therapy for substance use disorders. Addiction 105(12): 2120-2127, 2010. (33 refs.)

Aims: To evaluate the changes over time in quality and quantity of coping skills acquired following cognitive behavioral therapy (CBT), and examine potential mediating effects on substance use outcomes. Design: A randomized controlled trial (RCT) evaluating the effectiveness of a computerized version of CBT (CBT4CBT) as an adjunct to standard out-patient treatment over an 8-week period. Setting: Data were collected from individuals seeking treatment for substance dependence in an out-patient community setting. Participants: Fifty-two substance abusing individuals (50% African American), with an average age of 42 years, and a majority reporting cocaine as their primary drug of choice. Measurements: Participants' responses to behavioral role-plays of situations associated with high risk for drug and alcohol use were audio-taped and rated independently to assess their coping responses. Findings: There were statistically significant increases in mean ratings of the quality of participants' coping responses for those assigned to CBT4CBT compared to treatment as usual, and these differences remained significant 3 months after treatment completion. Moreover, quality of coping responses mediated the effect of treatment on participants' duration of abstinence during the follow-up period. Conclusions: These findings suggest that assignment to the computerized CBT program improved participants' coping skills, as measured by independent ratings of a role-playing task. It is also the first study to test and support quality of coping skills acquired as a mediator of the effect of CBT for substance use.

Lejoyeux M; Weinstein A. Compulsive buying. American Journal of Drug and Alcohol Abuse 36(5): 248-253, 2010. (52 refs.)

Background: Compulsive buying is a chronic, repetitive purchasing that becomes a primary response to negative events and feelings, and may include symptoms equivalent to craving and withdrawal. Objectives: This article describes the addictive characteristics of compulsive buying, the psychiatric comorbidity, and the possibilities of treatment. Methods: Using PubMed and MedLine search engines, we performed a review of published literature over the period 1990-2010 using the keyword "compulsive buying". Results: A key feature distinguishing compulsive buyers from normal consumers, collectors, and hoarders is that the former focuses on the buying process itself, rather than the items bought. In this instance, the purchased items are usually never used, but tend to be hidden or thrown away. A recent screening study found that up to 5% of adult Americans appear to be afflicted with this compulsion. Compulsive buying results in adverse consequences, including financial and legal problems, psychological distress (depression, guilt), and interpersonal conflict. The most commonly associated comorbidities are depression and eating disorders. Nothing is known about the neurobiology and genetics of compulsive buying and relatively little about its treatment. Cognitive behavioral therapy has some efficacy, but no medication has been effective in controlled trials. Conclusions: Compulsive buying can be described as a behavioral dependence. A great deal of future research is needed to improve our understanding of compulsive buying.

Levine MD; Perkins KA; Kalarchian MA; Cheng Y; Houck PR; Slane JD et al. Bupropion and cognitive behavioral therapy for weight-concerned women smokers. Archives of Internal Medicine 170(6): 543-550, 2010. (25 refs.)

Background: We previously documented that cognitive behavioral therapy for smoking-related weight concerns (CONCERNS) improves cessation rates. However, the efficacy of combining CONCERNS with cessation medication is unknown. We sought to determine if the combination of CONCERNS and bu-propion therapy would enhance abstinence for weight-concerned women smokers. Methods: In a randomized, double-blind, placebo-controlled trial, weight-concerned women (n =349; 86% white) received smoking cessation counseling and were randomized to 1 of 2 adjunctive counseling components: CONCERNS or STand ARD (standard cessation treatment with added discussion of smoking topics but no specific weight focus), and 1 of 2 medication conditions: bupropion hydrochloride sustained release (B) or placebo (P) for 6 months. Rates and duration of biochemically verified prolonged abstinence were the primary outcomes. point-prevalent abstinence, postcessation weight gain, and changes in nicotine withdrawal, depressive symptoms, and weight concerns were evaluated. Results: Women in the CONCERNS + B group had higher rates of abstinence (34.0%) and longer time to relapse than did those in the STand ARD + B (21%; P = .05) or CONCERNS + p (11.5%; P = .005) groups at 6 months, although rates of prolonged abstinence in the CONCERNS + B and STand ARD + B groups did not differ significantly at 12 months. Abstinence rates and duration did not differ in the STand ARD + B group (21% and 19%) compared with the STand ARD + P group (10% and 7%) at 6 and 12 months, respectively. There were no difference among abstinent women in postcessation weight gain or weight concerns, although STand ARD + B produced greater decreases in nicotine withdrawal and depressive symptoms than did STand ARD + P. Conclusions: Weight-concerned women smokers receiving the combination of CONCERNS + B were most likely to sustain abstinence. This effect was not related to differences in postcessation weight gain or changes in weight concerns.

Longabaugh R. Commentary on Kiluk, et a.l (2010): The emperor has some new clothes - coping is a mediator of cognitive-behavioral therapy's effectiveness. (editorial). Addiction 105(12): 2128-2129, 2010. (13 refs.)

Lubman DI; King JA; Castle DJ. Treating comorbid substance use disorders in schizophrenia. International Review of Psychiatry 22(2): 191-201, 2010. (74 refs.)

Aim: To review the literature on pharmacological and psychosocial treatment approaches for people with schizophrenia and comorbid substance use disorder(s) (SUD). Method: Selective literature review. Results: Despite the high prevalence of comorbid SUD among people with schizophrenia, there is a considerable paucity of rigorously conducted randomized controlled treatment trials. While there is some evidence for clozapine, and for the adjunctive use of agents such as naltrexone for comorbid alcohol dependence, the available literature largely comprises case studies, case series, open label studies and retrospective surveys. In terms of psychosocial approaches, there is reasonable consensus that integrated approaches are most appropriate. Regarding specific aspects of care, motivational interviewing, cognitive behavioural therapy and contingency management have an emerging supportive literature, as do family interventions. However, there is no 'one size fits all', and a flexible approach with the ability to apply specific components of care to particular individuals, is required. Group-based therapies and longer-term residential services have an important role for some patients, but further research is required to delineate more clearly which patients will benefit from these strategies. Conclusions: While there is growing (albeit limited) evidence that integrated and well articulated interventions that encompass pharmacological and psychosocial parameters can be beneficial for people with schizophrenia and comorbid SUD, there remains a considerable gap in the literature available to inform evidence-based practice.

Lydecker KP; Tate SR; Cummins KM; McQuaid J; Granholm E; Brown SA. Clinical outcomes of an integrated treatment for depression and substance use disorders. Psychology of Addictive Behaviors 24(3): 453-465, 2010. (53 refs.)

The authors compared longitudinal treatment outcomes for depressed substance-dependent veterans (N = 206) assigned to integrated cognitive-behavioral therapy plus standard pharmacotherapy (ICBT + P) or 12-step facilitation therapy plus standard pharmacotherapy (TSF + P). Drug and alcohol involvement and depressive symptomology were measured at intake and at 3-month intervals during treatment and up to 1 year posttreatment. Participants in both treatment conditions showed decreased depression and substance use from intake. ICBT + P participants maintained improvements in substance involvement over time, whereas TSF + P participants had more rapid increases in use in the months following treatment. Decreases in depressive symptoms were more pronounced for TSF + P than ICBT + P in the 6 months posttreatment. Within both treatment groups, higher attendance was associated with improved substance use and depression outcomes over time. Initial levels of depressive symptomology had a complex predictive relationship with long-term depression outcomes. Early treatment response predicted long-term substance use outcomes for a portion of the sample. Although both treatments were associated with improvements in substance use and depression, ICBT + P may lead to more stable substance use reductions compared with TSF + P.

Macgowan MJ; Engle B. Evidence for optimism: Behavioral therapies and motivational interviewing in adolescent substance abuse treatment. Child and Adolescent Psychiatric Clinics of North America 19(3): 527+, 2010. (68 refs.)

This article reviews behavior therapies, motivational interviewing interventions, and combined behavioral-psychosocial therapies across 34 peer-reviewed publications. Studies were included if they involved youth with alcohol and other drug (AOD) use, included measures of AOD outcomes, and used controlled research designs with a control or comparison condition. The level of empirical support of the interventions was evaluated using established guidelines. The article determined that behavior therapies were "probably efficacious," and motivational interviewing interventions easily met the criteria for "promising." Because of small sample sizes, combined behavioral-psychosocial therapies marginally met the criteria for "promising." The findings from this article underscore the value of individual and group behavior therapies and motivational interviewing in helping reduce mild to serious AOD use among adolescents.

Mc Carthy PM; O'Sullivan D. Efficacy of a brief cognitive behavioral therapy program to reduce excessive drinking behavior among new recruits entering the Irish navy: A pilot evaluation. Military Medicine 175(11): 841-846, 2010. (28 refs.)

This pilot study evaluated the efficacy of a brief cognitive behavioral therapy (CBT) intervention program designed to reduce excessive pre-enlistment drinking behaviors in a sample of Irish Navy recruits undergoing a 16-week basic training course. Participants were randomly allocated to either a treatment (TG) or control group (CG) (N = 13 each). The program was conducted over four consecutive 1.5-hour weekly sessions. Data were collected at pre and post intervention as well as at a 2-month follow-up. In comparison to those in the control group, participants who received the intervention reported increased scores (p < 0.05) in readiness to change drinking at time 2 and reduced scores in binge drinking (p < 0.05) at time 3. There were also marginal changes in self-efficacy and risky drinking behavior. This work adds to the evidence of the emerging efficacy of a workplace CBT intervention for unhealthy drinking.

McHugh RK; Hearon BA; Otto MW. Cognitive behavioral therapy for substance use disorders. Psychiatric Clinics of North America 33(3): 511-525, 2010. (78 refs.)

Cognitive behavioral therapy (CBT) for substance use disorders has shown efficacy as a monotherapy and as part of combination treatment strategies. This article provides a review of the evidence supporting the use of CBT, clinical elements of its application, novel treatment strategies for improving treatment response, and dissemination efforts. Although CBT for substance abuse is characterized by heterogeneous treatment elements such as operant learning strategies, cognitive and motivational elements, and skills-building interventions, across protocols several core elements emerge that focus on overcoming the powerfully reinforcing effects of psychoactive substances. These elements, and support for their efficacy, are discussed.

Miller JM; Miller HV. Considering the effectiveness of drug treatment behind bars: Findings from the South Carolina RSAT Evaluation. Justice Quarterly 28(1): 70-86, 2011. (39 refs.)

Through funding from the national Residential Substance Abuse Treatment Program, the South Carolina Department of Corrections implemented the Correctional Recovery Academy in the Turbeville Medium Security Institution to treat drug-dependent offenders. The program features a cognitive-behavioral change modality delivered in a modified therapeutic community to first time, non-violent, drug-dependent, youthful male offenders. A quasi-experimental design was employed to specify impact as indicated by recidivism, relapse, and parole revocation. While analyses revealed no statistically significant difference between treatment and control group participants on these outcome measures, implications regarding the efficacy of the treatment modality are ambiguous as implementation failure masked determination of program effects. Drug testing frequency after release, however, was found to be a significant factor precluding failure, contrary to the conventional view that increased testing identifies greater use.

Murthy P; Subodh BN. Current developments in behavioral interventions for tobacco cessation. Current Opinion in Psychiatry 23(2): 151-156, 2010. (42 refs.)

Purpose of review Tobacco use causes a significant amount of mortality and morbidity globally. The search for optimal cost-effective treatment interventions continues as current treatment modalities at best offer modest success in treatment outcome. This review evaluates current developments in behavioral interventions for tobacco cessation and their effectiveness. Recent findings: Most studies of behavioral interventions reported moderate success in quitting tobacco at 6 months. This finding is seen across different professionals providing interventions in diverse settings using various modalities. Behavioral interventions in adolescents and pregnancy seem presently more effective than pharmacotherapy. Technology-driven interventions have gained recent popularity. Combining interventions shows promising results compared with a single intervention. Summary: Most tobacco cessation intervention studies are from developed countries and for cigarette smoking. Long-term cessation still poses a challenge. Given the high global morbidity and mortality, there is a need to develop evidence-based, cost-effective intervention in developing countries for both smoking and smokeless tobacco use. Tobacco addiction produces neurobiological and behavioral change and optimal approaches involving behavioral methods and pharmacotherapy need to be developed.

Oliveto A; Poling J; Mancino MJ; Feldman Z; Cubells JF; Pruzinsky R et al. Randomized, double blind, placebo-controlled trial of disulfiram for the treatment of cocaine dependence in methadone-stabilized patients. Drug and Alcohol Dependence 113(2-3): 184-191, 2011. (67 refs.)

This study examined the dose-related efficacy of disulfiram for treating cocaine dependence in methadone-stabilized cocaine dependent participants. Design: One hundred and sixty-one cocaine- and opioid-dependent volunteers were entered into a 14-week, double blind, randomized, placebo-controlled clinical trial at two sites. Methods: Participants were stabilized on methadone during weeks 1-2 and received disulfiram at 0, 62.5, 125 or 250 mg/day during weeks 3-14. All participants also received weekly cognitive behavioral therapy. Thrice-weekly urine samples and weekly self-reported drug use assessments were obtained. Results: Baseline subject characteristics, retention and drug use did not differ across groups. Outcome analyses were performed on those who participated beyond week 2. Opioid-positive urine samples and self-reported opioid use did not differ by treatment group. The prevalence of alcohol use was low prior to and during the trial and did not differ by treatment group. Cocaine-positive urines increased over time in the 62.5 and 125 mg disulfiram groups and decreased over time in the 250 mg disulfiram and placebo groups (p<0.0001). Self-reported cocaine use increased in the 125 mg disulfiram group relative to the other three treatment groups (p = 0.04). Conclusions: Disulfiram may be contraindicated for cocaine dependence at doses <250 mg/day. Whether disulfiram at higher doses is efficacious in reducing cocaine use in dually cocaine and opioid dependent individuals needs to be determined.

Olmstead TA; Ostrow CD; Carroll KM. Cost-effectiveness of computer-assisted training in cognitive-behavioral therapy as an adjunct to standard care for addiction. Drug and Alcohol Dependence 110(3): 200-207, 2010. (30 refs.)

Aim: To determine the cost-effectiveness, from clinic and patient perspectives, of a computer-based version of cognitive-behavioral therapy (CBT4CBT) as an addition to regular clinical practice for substance dependence. Participants, design and measurements: This cost-effectiveness study is based on a randomized clinical trial in which 77 individuals seeking treatment for substance dependence at an outpatient community setting were randomly assigned to treatment as usual (TAU) or TAU plus biweekly access to computer-based training in CBT (TAU plus CBT4CBT). The primary patient outcome measure was the total number of drug-free specimens provided during treatment. Incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves (CEACs) were used to determine the cost-effectiveness of TAU plus CBT4CBT relative to TAU alone. Results are presented from both the clinic and patient perspectives and are shown to be robust to (i) sensitivity analyses and (ii) a secondary objective patient outcome measure. Findings: The per patient cost of adding CBT4CBT to standard care was $39 ($27) from the clinic (patient) perspective. From the clinic (patient) perspective, TAU plus CBT4CBT is likely to be cost-effective when the threshold value to decision makers of an additional drug-free specimen is greater than approximately $21 ($15), and TAU alone is likely to be cost-effective when the threshold value is less than approximately $21 ($15). The ICERs for TAU plus CBT4CBT also compare favorably to ICERs reported elsewhere for other empirically validated therapies, including contingency management. Conclusions: TAU plus CBT4CBT appears to be a good value from both the clinic and patient perspectives.

Schnoll RA; Martinez E; Tatum KL; Glass M; Bernath A; Ferris D et al. Increased self-efficacy to quit and perceived control over withdrawal symptoms predict smoking cessation following nicotine dependence treatment. Addictive Behaviors 36(1-2): 144-147, 2011. (23 refs.)

Aim To examine changes in nicotine withdrawal nicotine craving self-efficacy to quit smoking and perceived control over withdrawal symptoms as predictors of smoking cessation following behavioral counseling and nicotine replacement therapy in a sample of smokers. Design and setting: The data were ascertained from a randomized effectiveness trial comparing nicotine patch to nicotine lozenge Predictors of smoking cessation were assessed at baseline and 5 weeks post-baseline and 24-hour point prevalence abstinence biochemically confirmed was assessed at the end of-treatment (week 15) and 6 months after a target quit date (week 27). Participants: 642 treatment-seeking smokers randomized to 12 weeks of nicotine patch or nicotine lozenge. Findings: Participants who showed a greater Increase in self efficacy to quit smoking (OR=1 09 95% CI 1 02-1 16 p=01) and perceived control over withdrawal symptoms (OR=1 02 95% CI 1 00-1 04 p=05) were significantly more likely to have quit smoking at week 15. Participants who showed a greater Increase in self-efficacy to quit smoking (OR=1 04 95% CI 1 01-106 p = 01) were significantly more likely to have quit smoking at week 27. Changes in withdrawal symptoms and craving were not related to week 15 or week 27 abstinence rates. Conclusions: The results highlight two relatively under-studied potential psychological predictors of abstinence following treatment for nicotine dependence. Behavioral counseling interventions to promote smoking cessation should help smokers develop confidence in their ability to quit smoking and increase their sense of control over withdrawal symptoms to increase their chances for cessation.

Schoenmakers TM; de Bruin M; Lux IFM; Goertz AG; Van Kerkhof DHAT; Wiers RW. Clinical effectiveness of attentional bias modification training in abstinent alcoholic patients. Drug and Alcohol Dependence 109(1-3): 30-36, 2010. (52 refs.)

A new training to decrease attentional bias (attentional bias modification training, ABM) was tested in a randomized controlled experimental study with alcohol-dependent patients as an addition to cognitive behavioral therapy. In alcohol dependence, attentional bias has been associated with severity of alcoholism, craving, treatment outcome, and relapse. Forty-three patients with DSM-IV diagnosis of alcohol dependence were randomly assigned to an ABM intervention or control training. The procedure consisted of five sessions in which patients were trained to disengage attention from alcohol-related stimuli (ABM condition) or in which they were trained on an irrelevant reaction-time test (control condition). We measured the effects of ABM on the visual-probe task, with stimuli that were presented in the ABM and with new stimuli. Craving was measured with the Desires for Alcohol Questionnaire. Follow-up data were gathered for overall treatment success, and relapse up to 3 months after the intervention. ABM was effective in increasing the ability to disengage from alcohol-related cues. This effect generalized to untrained, new stimuli. There were no significant effects on subjective craving. For other outcome measures there were indications of clinically relevant effects. Results indicate that ABM among alcohol-dependent patients was effective and that it may affect treatment progression. Large-scale trials are warranted to further investigate this new field.

Smout MF; Longo M; Harrison S; Minniti R; Wickes W; White JM. Psychosocial treatment for methamphetamine use disorders: A preliminary randomized controlled trial of cognitive behavior therapy and acceptance and commitment therapy. Substance Abuse 31(2): 98-107, 2010. (35 refs.)

Acceptance and Commitment Therapy (ACT) incorporates developments in behavior therapy, holds promise but has not been evaluated for methamphetamine use disorders. The objective of this study was to test whether ACT would increase treatment attendance and reduce methamphetamine use and related harms compared to cognitive behavior therapy (CBT). One hundred and four treatment-seeking adults with methamphetamine abuse or dependence were randomly assigned to receive 12 weekly 60-minute individual sessions of ACT or CBT. Attrition was 70% at 12 weeks and 86% at 24 weeks postentry. Per intention-to-treat analysis, there were no significant differences between the treatment groups in treatment attendance (median 3 sessions), and methamphetamine-related outcomes; however, methamphetamine use (toxicology-assessed and self-reported), negative consequences, and dependence severity significantly improved over time in both groups. Although ACT did not improve treatment outcomes or attendance compared to CBT, it may be a viable alternative to CBT for methamphetamine use disorders. Future rigorous research in this area seems warranted.

Song FJ; Huttunen-Lenz M; Holland R. Effectiveness of complex psycho-educational interventions for smoking relapse prevention: An exploratory meta-analysis. Journal of Public Health 32(3): 350-359, 2010. (84 refs.)

Existing systematic reviews have concluded that psycho-educational interventions for smoking relapse prevention were ineffective. Our objective was to conduct an exploratory meta-analysis, guided by mechanisms of these complex interventions for preventing smoking relapse. Relevant trials were identified from a Cochrane review and by an updated search of MEDLINE and PsycINFO (up to August 2009). We examined theories or mechanisms underlying relapse prevention interventions, and process variables reported in trials. Odds ratios (ORs) for the rate of smoking abstinence at the longest follow-up were pooled in meta-analysis. Forty-nine trials were included, and interventions were at least partly based on the cognitive-behavioural approach to coping skills training in 41 trials. Only a few trials reported data on process variables. Coping skills training for smoking relapse prevention was effective for community quitters (OR 1.27, 95% CI: 1.08-1.49), and particularly for those who stopped smoking for at least 1 week at baseline (OR 1.52, 95% CI: 1.20-1.93). These findings were interpretable with mechanisms of coping skills training for relapse prevention. On the basis of post hoc subgroup analyses, coping skills training for smoking relapse prevention is effective for motivated community quitters. This finding has important public health implications and needs to be confirmed by further trials.

Sonne SC; Nunes EV; Jiang HP; Tyson C; Rotrosen J; Reid MS. The relationship between depression and smoking cessation outcomes in treatment-seeking substance abusers. American Journal on Addictions 19(2): 111-118, 2010. (32 refs.)

The National Drug Abuse Treatment Clinical Trials Network (CTN) recently completed a randomized, open label trial comparing treatment as usual (TAU) combined with nicotine patches plus cognitive behavioral group counseling for smoking cessation (n = 153) to TAU alone (n = 72) for patients enrolled in treatment programs for drug or alcohol dependence, who were interested in quitting smoking. This report is a secondary analysis evaluating the effect of depressive symptomatology (n = 70) or history of depression (n = 110) on smoking cessation outcomes. A significant association was seen between measures of depression and difficulty quitting cigarettes. Specifically, there was a greater probability for smoking abstinence for those with lower baseline Beck Depression Inventory II (BDI-II) scores. These data suggest that evaluation and treatment of depressive symptoms may play an important role in improving smoking cessation outcomes.

Steiger J; Muller A. Compulsive buying. Psychotherapeut 55(5): 429-439, 2010. (29 refs.)

Compulsive buying (CB) is characterized by the senseless und uncontrollable acquisition of items. The main focus is on the act of buying and the purchased items are afterwards hardly used or not even at all. The repeated excessive behavior leads to psychological, social and financial problems. In addition to their buying behavior most individuals with CB also suffer from other mental disorders, especially depression, anxiety disorders, personality disorders and impulse control disorders. There is an ongoing discussion about the appropriate diagnosis and currently CB is classified as an impulse control disorder not otherwise specified. In the treatment of CB controlled psychotherapy studies indicated the efficacy of cognitive behavioral therapy while the benefit of pharmacotherapy still needs to be confirmed. Additional research is necessary concerning classification, etiology and the development of differential therapy programs.

Sugarman DE; Nich C; Carroll KM. Coping strategy use following computerized cognitive-behavioral therapy for substance use disorders. Psychology of Addictive Behaviors 24(4): 689-695, 2010. (36 refs.)

Coping strategies are emerging as a predictor of treatment outcome for substance users and may be particularly important among computerized and self-change approaches. We used data from a randomized clinical trial of a computer-based version of cognitive-behavioral therapy (CBT4CBT) to: (1) examine the association between observer ratings of coping skills and self-reported coping strategies; (2) evaluate whether participants assigned to the CBT4CBT program reported greater use of coping strategies compared with those not exposed to the program; and (3) examine the differential effect of coping strategies by treatment group on drug-related outcomes. Individuals (N = 77) seeking treatment for substance dependence at a community-based outpatient substance abuse treatment facility were recruited and randomized to receive treatment-as-usual (TAU). or TAU plus CBT4CBT. with the Coping Strategies Scale administered at baseline and posttreatment. Self-reported coping strategy use was strongly correlated with observer ratings on a role-play assessment of coping skills. Although no significant group differences were found across time for coping strategy use, results suggested that as coping strategy use increased, drug use decreased, and this relationship was stronger for participants who received CBT4CBT.

Tober G. Commentary on Witkiewitz et al. (2010): Evidence for matching-at last. (commentary). Addiction 105(8): 1414-1415, 2010. (17 refs.)

Vosburg SK; Haney M; Rubin E; Foltin RW. Using a novel alternative to drug choice in a human laboratory model of a cocaine binge: A game of chance. Drug and Alcohol Dependence 110(1-2): 144-150, 2010. (29 refs.)

Human laboratory studies have shown that, once initiated, cocaine self-administration is difficult to disrupt using non-drug alternatives. This inpatient study examined whether binge self-administration of cocaine could be altered by an immediate, non-drug reinforcer. Ten cocaine-dependent participants completed 5 consecutive laboratory session days with 2 sessions per day (a model binge), 9 days where cocaine was not available, and subsequent 2 laboratory session days where cocaine was again available (a second model binge). In each laboratory session, participants could choose to either self-administer smoked cocaine or play a game of chance by drawing a pre-determined number of balls from a bingo wheel. Balls were worth monetary amounts from $0 to $20. Participants' choice to smoke cocaine varied as a function of number of balls drawn. Thus, this game of chance served as an alternative reinforcer to smoking cocaine. Choice varied lawfully as a function of the number of opportunities to earn money indicating that an immediate behavioral alternative can reduce cocaine self-administration after initiation of use. The current model could be used to evaluate whether behavioral and pharmacological manipulations shift choice from cocaine to a non-drug alternative.

Willemsen MC; De Vries H. Breaking a lance for using social cognitive theories to understand addictive behaviours more clearly and using planning models to change them. (editorial). Addiction 105(11): 1895-1897, 2010. (14 refs.)

Witkiewitz K; Hartzler B; Donovan D. Matching motivation enhancement treatment to client motivation: Re-examining the Project MATCH motivation matching hypothesis. Addiction 105(8): 1403-1413, 2010. (51 refs.)

Aims: The current study was designed to re-examine the motivation matching hypothesis from Project MATCH using growth mixture modeling, an analytical technique that models variation in individual drinking patterns. Design, setting and participants: Secondary data analyses of data from Project MATCH (n = 1726), a large multi-site alcoholism treatment-matching study. Measurements: Percentage of drinking days was the primary outcome measure, assessed from 1 month to 12 months following treatment. Treatment assignment, alcohol dependence symptoms and baseline percentage of drinking days were included as covariates. Findings: The results provided support for the motivation matching hypothesis in the out-patient sample and among females in the aftercare sample: the majority of individuals with lower baseline motivation had better outcomes if assigned to motivation enhancement treatment (MET) compared to those assigned to cognitive behavioral treatment (CBT). In the aftercare sample there was a moderating effect of gender and alcohol dependence severity, whereby males with lower baseline motivation and greater alcohol dependence drank more frequently if assigned to MET compared to those assigned to CBT. Conclusions: Results from the current study lend partial support to the motivation-matching hypothesis and also demonstrated the importance of moderating influences on treatment matching effectiveness. Based upon these findings, individuals with low baseline motivation in out-patient settings and males with low levels of alcohol dependence or females in aftercare settings may benefit more from motivational enhancement techniques than from cognitive-behavioral techniques.